Active NPI
Nicholas Joseph Wagner, DDS
- Dentist
- Boonville, IN
National Provider Identifier
1023338480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12011465A
- Practice address
- 800 Office Park Dr
Boonville, IN 47601-8601 - Phone
- (812) 897-4889
- NPI assigned
- Jun 9, 2010
- Last updated
- Jan 23, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12011465A | IN | Primary |
Addresses
Primary practice location
800 Office Park Dr
Boonville, IN 47601-8601
Mailing address
800 Office Park Dr
Boonville, IN 47601-8601
Phone (812) 897-4889
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150513002599 | IN | Order and Referring Only - Dentist | 8426378597 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Warrick Park Dental, LLP | Current | Accepting new patients |
Locations
800 Office Park Dr
Boonville, IN 47601
Phone (812) 897-4889
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Boonville, IN
- NPI 1952988594
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579737600000",
"number": "1023338480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 OFFICE PARK DR",
"city": "BOONVILLE",
"state": "IN",
"postal_code": "476018601",
"telephone_number": "812-897-4889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 OFFICE PARK DR",
"city": "BOONVILLE",
"state": "IN",
"postal_code": "476018601",
"telephone_number": "812-897-4889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "NICHOLAS",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-09",
"last_updated": "2020-01-23",
"certification_date": "2020-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12011465A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boonville, IN
- Tiny Triumphs Pediatric Therapy , LLC
- Tri-State Behavioral Health LLC
- David Vaughn, MD
- Vituity-HM Services PC
- James Volz
- Wal-Mart Stores East LP (Walmart Pharmacy 10-0566)
- Wal-Mart Stores East, LP (Vision Center 30-0566)
- Warrick County Health Department
- Warrick County School Corp.
- Warrick Park Dental
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.